Provider Demographics
NPI:1740642453
Name:OLUWOLE, OLUBUSOLA (MD)
Entity type:Individual
Prefix:
First Name:OLUBUSOLA
Middle Name:
Last Name:OLUWOLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 5TH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3427
Mailing Address - Country:US
Mailing Address - Phone:412-647-6124
Mailing Address - Fax:
Practice Address - Street 1:3601 FITH AVENUE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2739
Practice Address - Country:US
Practice Address - Phone:412-647-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD479555207RH0000X
390200000X
WAMD61088026207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1740642453Medicaid
PAMD479555Medicaid